services for the individual and the community varies widely and, in general, remains far below the levels of the more developed regions. National leaders and the public aspire to a level of health services that will reduce mortality still further and increase the health and well-being of the people. However, as with education and other public services, high fertility forces health ministries to run fast to stay in the same placeŚlet alone improve services. Unlike other services, however, personal health services can have a direct effect upon population growth by reducing mortality and by providing family planning services. Governmental health expenditures in most developing countries are between 0.3 and 2.5 percent of GNP, ranging from less than 30 cents to several dollars per person per year. In most developed countries these expenditures are between $13 and about $75 per person and the fraction of GNP is usually between 1 and 4 percent. Population Growth and Personal Health Services For the next 20 years at least, the demand for health services will outrun the supply-by any measure such as doctor/population ratios or number of hospital beds. Rapidly growing population combined with higher aspirations make this inevitable. A study of doctor manpower needs from 1955 to 1965 in thirty-one developing countries illustrates the problem of numbers.* To maintain the doctor/population ratios of 1955, 25 percent more doctors were needed because of rapid population growth. To increase the doctor/ population ratio by 3.3 physicians per 100,000 people, from 17.9 to 21.1, 50 percent more doctors were needed by the end of the 10-year period. At zero population growth, only 18.5 percent more doctors would have been needed. The age and geographical distribution of the population also affects the health services. In a high-fertility community the primary stress on health services will be the care of mothers and children. The problems of medical treatment for infants are substantially greater than the problems of treating young adults, and hence care of the young requires a higher doctor/ population ratio than the care of people aged 15 to 45. The levels of personal health services are usually much higher in urban areas than in rural ones, both in terms of numbers of physicians per capita and in facilities. In a high-fertility region many women have several pregnancies very early in their childbearing years and continue to bear children up to the time of menopause. Very young mothers, older mothers, mothers with closely spaced tion Growth for Health Services in Less Developed Countries-An Initial Appraisal"; and Abdel R. Ornran, "Abortion in the Demographic Transition." * World Health Statistics Report, Vol. 21, No. 11, Geneva, 1969.